Deborah Davis - Act Government Health Directorate and University of Canberra

1. COERCION AND CONSENT IN MATERNITY CARE
Obstetric Malpractice Conference
8-9th August 2017, Melbourne

3. SACKETT ET AL
Clinician
Evidence
Evidence
based
care
Patient

4. ANDREA

5. “She had her baby and I had my normal birth”.

6. SACKETT ET AL
Evidence
Evidence
based
care
Patient
Clinician

7. Ò What happens when the values and
preferences of the women in our care depart
significantly from ours?
Ò What happens when they diverge also from
evidence and best practice?
Ò Do the values and expertise of the health
professional matter anyway?

10. “Well, for me it comes down to being with
women and for me it's very important that the
woman is actually the lead person. But I am
there to give her information to help her make
her choices but it is up to her to make the
choices. And it’s my job to give the information
and then if she makes a choice it’s my job to
make that choice as safe as possible but still
working with her”.

11. “I think that we are really clear about the
way we work, that we want to work with people
and encourage them to find their way and that we
share information, we'll find information, and
we’ll help them find information. We're not going
to tell them what to do and that is about them
taking responsibility. … “

12. “And we're really clear with some people
that you know often think, "Well I want you to
make a decision that will be OK". We're really
clear that if you ask us our personal opinion that
we won’t give it, so that won’t influence their
decision-making.”

13. “That makes it sound like you've got no values or
views as a midwife…”

15. LUPTON
In their interactions with health care
professionals
“lay people may pursue both the ideal type
‘consumerist’ and the ‘passive patient’ subject
position simultaneously or variously, depending
on the context…”

16. SACKETT ET AL
Clinician
Evidence
based
care
Patient
Evidence

17. Do the values and expertise of the health
professional matter anyway?

18. BIOETHICAL MODEL OF INFLUENCE

19. “The culture into which the leaflets
were introduced supported existing
normative patterns of care and this
ensured informed compliance rather
than informed choice.”

20. Ò What happens when the values and
preferences of the women in our care depart
significantly from ours?
Ò What happens when they diverge also from
evidence and best practice?
Ò Do the values and expertise of the health
professional matter anyway?

22. BIOETHICAL MODEL OF INFLUENCE

23. SACKETT ET AL
Evidence
Evidence
based
care
Patient
Clinician

24. It is easy to support informed choice and
consent when patients make choices that align
with our preferences or the norms of our
profession.

28. Often I'll say "even the colostrum is brilliant,
if you feel you could let the baby have that" and
as she took little steps of "maybe, maybe, maybe"
and just got a bit further and a bit further on and
like six weeks postpartum she was still breast
feeding beautifully, you know….

29. SACKETT ET AL
Clinician
Evidence
Evidence
based
care
Patient